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. 2019 Aug 8;2019(8):CD006869. doi: 10.1002/14651858.CD006869.pub3

Ryding 2004.

Methods Design: RCT
Participants Setting: hospital obstetrics and gynaecology department
Type of trauma exposure: EmCS
Inclusion criteria: all Swedish‐speaking women giving birth to a live infant by EmCS at the participating hospital
Exclusion criteria: non‐Swedish speakers
Sample size: 217 women met the inclusion criteria; 162 were randomised.
Mean age: 32 (SD not specified) years, range 19–44 years
Gender: 162 (100%) women
Ethnicity: not specified
Country: Sweden
162 women who had experienced birth by EmCS. Intervention offered to all.
Interventions Group 1: group counselling: n = 89
4 or 5 women were invited to each of the EmCS groups. The group leaders were a maternity and child welfare psychologist and an experienced delivery ward midwife. Consultations lasted for 2 hours, and the groups met twice at a 2‐ to 3‐week interval. The main purpose was to arrange for participants to meet other women who had undergone EmCS so that they could share experiences. It was hoped that the women would be able to discuss both medical procedures (the midwife would have the answers) and psychological matters, such as feelings after a traumatic birth and feelings about motherhood and the baby (the psychologist would be able to provide counselling). It also hoped to identify new mothers in need of individual contact and to provide information about the possibilities of further help.
Group 2: TAU: n = 73
Women offered an individual consultation to discuss their recent delivery, if they wished, after completing outcome questionnaires at 6 months' postpartum. Standard care after an EmCS included the midwife and doctor involved in the procedure visiting the mother in the maternity ward so as to exchange information about the experience, although for practical reasons this was not always possible.
Outcomes PTSD: IES
Other: Wijma Expectancy/Experience Questionnaire; EPDS
Follow‐up: 6 months
Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) High risk Women who gave birth on approximately 18 predetermined days of the month were randomised to the counselling group, and the remainder to the control group.
Allocation concealment (selection bias) High risk Women who gave birth on approximately 18 predetermined days of the month were randomised to the counselling group, and the remainder to the control group.
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk All measures where self‐report which participants completed by post.
Incomplete outcome data (attrition bias) 
 All outcomes Unclear risk Analyses were based on the number of questionnaires returned. Response rate was high for both groups. Data were reported by median and interquartile range. The reason for this was unclear but may have been because of skew.
Selective reporting (reporting bias) Unclear risk No study protocol identified.
Other bias Unclear risk The group intervention was not manualised and was provided through semi‐structured delivery. Treatment adherence was not reported.